US Healthcare Systems Exam 1 (Ch 1-6) With complete solutions
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Course
Nurrsing
Institution
Nurrsing
What are the basic components of a Health Services Delivery System?
1. Financing - how services are paid for
2. Insurance - protects against catastrophic risks
3. Delivery - provision of health care services by various providers
4. Payment - reimbursement to providers for services delivered
...
US Healthcare Systems Exam 1 (Ch 1-6)
Wit complete solutions
What are the basic components of a Health Services Delivery System? - ANSWER-1.
Financing - how services are paid for
2. Insurance - protects against catastrophic risks
3. Delivery - provision of health care services by various providers
4. Payment - reimbursement to providers for services delivered
What are 5 key components of the Affordable Care Act (ACA)? - ANSWER-1. Individual
mandate
2. Insurance plans must cover "essential health benefits"
3. Insurance available for purchase on a web-based exchange
4. Expansion of Medicaid
5. Employer mandate to provide insurance for employees
What does managed care seek to achieve? - ANSWER-1. Seeks to achieve efficiencies
by integration of the 4 functions of health care.
2. Employs mechanisms to control utilization of medical services.
3. Determines the price at which the services are purchased and how much providers
get paid.
What is the iron triangle of healthcare delivery? - ANSWER-Access, cost, quality
Describe health care in the Pre-Industrial Era (Mid-18th to late 19th century) -
ANSWER-The consumer was sovereign in the market and healthcare was delivered
under free market conditions.
Medical practice was in disarray, medical procedures were primitive, the institutional
core was missing, demand was unstable, and medical education was substandard.
What are 5 reasons medical practice was insignificant during the Pre-Industrial Era? -
ANSWER-1. Medical practice was in disarray
2. Medical procedures were primitive
,3. Institutional core was missing
4. Demand was unstable
5. Medical education was substandard
Why was demand for medical care unstable in the Pre-Industrial Era? - ANSWER-
Opportunity cost of time spent and money spent traveling to the doctor were too high.
Demand was limited by economic conditions and the traditional practice of medicine in
rural eras.
Describe health care during the Post-Industrial Era (late 19th to late 20th century). -
ANSWER-1. Growth of professional sovereignty - as tech/meds advanced, status of
physicians rose.
2. Physicians succeeded in retaining private practice of medicine and resisting national
healthcare.
3. Employers took on a well-defined role in providing health care.
4. Growth of private health insurance.
5. Development of public health
Why did physicians rise to positions of power in the 1920s? - ANSWER-1. Urbanization
2. Science and technology / cultural authority
3. Institutionalization / pooling of resources
4. Dependency
5. Autonomy and organization (professional cohesiveness)
6. Licensing
7. Educational reform
Describe organized medicine. - ANSWER-The concerted efforts of physicians through
the AMA which equated to professional cohesiveness.
What 3 factors prompted the general need for health insurance? - ANSWER-1.
Technological - advanced treatments that were desirable but expensive.
2. Social - desirability of medical treatments.
3. Economic - risk of catastrophic loss.
What 3 reasons led to the growth of employer-based health insurance? - ANSWER-1.
Wage freeze during WWII - employers offered insurance as a benefit in lieu of more
money.
2. 1948 Supreme Court ruling - employee benefits were legit part of union-management
negotiations.
3. 1954 IRS tax code revision - made employer-paid health insurance tax deductible for
employers, tax-exempt for employees.
, Describe the 4 parts of Medicare. - ANSWER-Part A - hospital and limited nursing home
coverage (automatic).
Part B - Covers physician bills. Pay separate from part A.
Part C (1997) - Medicare managed care.
Part D (2006) - Prescription drugs.
Describe Medicaid. - ANSWER-- Helps indigent populations pay for health care.
- Eligibility determined via a means test.
- A state run program, funded in part by federal government to match state contributions
(Kerr-Mills Act).
What is the role of medical technology in health care delivery? - ANSWER-A tool to
improve the efficiency, effectiveness, safety, and patient health. Excessive use of
technology must be balanced with cost - what is the point of diminishing returns?
What are some applications of IT and informatics in the delivery of health care? -
ANSWER-- Decision support systems (Often embedded in EHR)
- Clinical information systems (Pharmacy data systems, Radiology & lab reporting
systems)
- Administrative information systems (Personnel management & scheduling)
What factors influence the creation, dissemination, and utilization of technology? -
ANSWER-1. Anthro-cultural beliefs and values
2. Medical specialization
3. Financing & payment
4. Technology-driven competition
5. Expenditures on research & development
6. Supply-side controls
7. Government policy
What is the government's role in technology diffusion? - ANSWER-Government funds
46% of medical technology R&D in the US. Aside from development, they have a
responsibility to intervene and ensure safety measures are in place as technology is
introduced into the marketplace (via the FDA).
technology diffusion. - ANSWER-The spread of technology into society once it is
developed.
What are some landmark pieces of legislation in the regulation of drugs and devices? -
ANSWER-1906 Food and Drugs Act
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